Analysis Of The Clinical Diagnosis And Treatment Of 72 Cases Brain Abscesses

Objective To analysis the clinical characteristics of brain abscess, in order to offer help for the early diagnosis and correct treatment of brain abscess, and to improve the prognosis of brain abscessesMethods A retrospective analysis of the clinical data of all patients with brain abscesses(BA) who were treated in the department of neurosurgery of Anhui Provincial Hospital Affiliated to Anhui Medical University was performed including age, sex, clinical manifestation, course of disease, infection mechanism, characteristics of brain abscesses, bacterial culture situation, treatments, complication and outcomes. All the patients followed up for 3 months to 4 years after discharge. The outcome was appraised through the Glasgow Outcome Scale(GOS), 1‐4 points were considered poor outcome and 5 points good outcome.Result There were 72 patients with brain abscesses diagnosed. The mean age was 41 years(rang: 5 monthes‐79 years). There were 47 male(65.28%) and 25 female(34.72%) patients. Most frequent presentations included headache(39/72, 54.17%), fever(29/72, 40.28%), and focal neurologic deficits(48/72, 66.67%). The mechanism of infection were cryptogenic(43/72, 59.72%), hematogenous(12/79, 16.67%), otogenic(7/72, 9.72%), iatrogenic(6/72, 8.33%), rhinogenic(3/72, 4.17%), and traumatic(1/72, 1.39%). CT and conventional MR imaging was performed in the 72 patients, and there are 63 cases in accordance with the typical imaging findings of brain abscesses‐a hypodenseparenchymal lesion with a complete rim of contrast enhancement on CT. And the abscess on MRI was a lesion with low signal on T1‐weighted nonenhanced images and high signal on T2‐weighted images, with a ring of enhancement surrounding the abscess. The abscess wall was smooth with no obvious nodules. But there were not typical imaging findings of brain abscesses on CT and MRI in 9 patients. There were 46 patients with diffusion weighted imaging(DWI), and there were 40 cases of vomica of the brain abscesses apparent diffusion limited, the vomica with high signal on DWI. There were 5 patients with the diffusion of their pus cavity is not fully constrained, were mainly high signal with low signal. Only 1 case showed low signal on DWI, but higher than cerebrospinal fluid. There were 7 cases with magnetic resonance spectrum examination. The obvious lactate peaks were detected in these 7 cases, but there were not multi‐amino acids peaks, acetic acid peaks or succinic acid peaks. Surgical excision of the abscess was performed in 43 patients, MR‐guided stereotactic puncture in 17 patients, and medical therapy alone in 12 patients. There are 17 patients with post‐operative complications. But these complications are not directly related with the operation. The 60 patients with brain abscesses who underwent surgical treatment were all with aerobic bacteria culture of pus, and 25 anaerobic bacteria culture. Aerobic bacteria culture positive(9 cases): Staphylococcus aureus(3 cases), Gram‐positive bacilli(2 cases), pseudomonas aeruginosa(2 cases), streptococcus viridians(1 case), and Acinetobacter baumannii(1 case). Anaerobic bacteria culture positive(3 cases): Gram‐positive anaerobic coccus(3 cases). As a result of this series 65 cases(90.28%) were cured: GOS 5 points(58 cases),GOS 4(5 cases), GOS 3(2 cases), and 7(9.72%) died.Conclusions CT and conventional MRI combine with DWI and MRS can be helpful to improve the diagnostic accuracy of brain abscesses, and identify brain abscess and intracranial tumors. On the basis of brain abscesses diagnosis accurately,comprehensive assessment and select the appropriate treatment, grasp the operation timing and indications for the treatment of brain abscess accurately, with individualized comprehensive treatment. The outcomes of patients with brain abscess will be further improved.